The attached application proposes that the Maternal-Fetal Medicine (MFM) Division of the Department of Obstetrics and Gynecology at the University of Cincinnati Medical Center (UCMC) be selected for continuation in the Cooperative Multicenter Network of Maternal-Fetal Medicine Units (MFMU). In the current funding period, the MFMU team has successfully screened, recruited, implemented, and collected data for all trials initiated by the MFMU steering committee. Furthermore, the MFM faculty has been instrumental in establishing new protocols for clinical trials to be conducted by the MFMU. The Health Care Alliance of Greater Cincinnati, consisting of the UCMC, the Christ Hospital (TCH), the St. Luke Hospital (SLH), UCMC administrators, members of the MFM Division, the Division of Neonatology, the Departments of Internal Medicine, Pathology, Biostatistics, Genetics, and Epidemiology are eager to continue its interaction with MFMU members in MFMU clinical trials. The MFM Division at the UCMC has established an excellent tradition of close cooperation with the other UCMC Departments during the planning and implementation of numerous joint programs funded by the National Institutes of Health (NIH). The academic strengths of the MFM Division are nationally recognized, and the faculty are well established and committed to academic pursuits. The combination of clinicians and basic scientists within the Division provides an ideal environment for meaningful collaborative research, allowing for current perinatal problems to be addressed in clinical trials while basic scientific issues are studied in the laboratory. In 1994, the Department of Obstetrics and Gynecology (Ob/Gyn) ranked second nationally among Departments of Ob/Gyn receiving NIH funding for research. The MFM faculty and services at UCMC are enhanced by a nationally-renowned neonatal faculty who believe that important and unresolved issues of perinatal care can only be solved by carefully planned prnspectjve clinical trials. Not only do the two faculties enjoy strong clinical, research, and training links, but the Greater Cincinnati Metropolitan region is unique in that there is a well established and successful Perinatal-Neonatal Outreach Program which ensures referral of all complicated pregnancies to the MFMU at UCMC. The commitment of UCMC and the Children's Hospital Medical Center (CHMC) to research is exemplified by the establishment of the Perinatal Research Institute devoted exclusively to perinatal and developmental research. The central theme of the Institute is the "prevention of problems in low birth weight infants," the major objective also of the NIH MFMU Network. Over 6000 primary and referral patients are seen at UCMC and TCH each year of whom 30% are high risk. This population far exceeds the requirements set by the RFA; furthermore, all patients are available for recruitment to the MFMU Network clinical trials. Our recruitment success in the current Network demonstrates that we have more than sufficient capabilities and resources to remain a successful member in the Cooperative Multicenter Network of Maternal-Fetal Medicine Units.